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Surgical vs Medical residencies

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13 years 7 months ago #57549 by TexasRose
I hope this will open a discussion about the differences in a surgical residency vs a medicine residency. I was specifically wondering if ladies from the different specialties could comment on the hours spent at the hospital, the number of times a week on call, and just generally the experience.

I've recently discovered that I'm much more interested in surgery than I thought I would be. The thing that makes me really question it is that so many people have warned me that I'll never see my family if I do a surgical residency. (I'm thinking of ortho, but I think it's relevant for any surg) However, it seems like all residents deal with the 80+ hour work week. Some surg residents say they just lie about the number of hours they work and that it's more like 100hrs/ week.

Could some of you in residency and beyond share with us what your training is/was like?

Thanks!

"All you have to decide is what to do with the time that is given to you."

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13 years 7 months ago #57550 by ormd
hi texasrose-

i think i've responded to this sort of question in other posts, but i'll try and address your specific question. you're absolutely right that the 80h rules have more or less equalized the hours across specialties; you're also right that surgical residents tend to lie or minimize their hours simply b/c there is SO MUCH WORK to do that we used to get done in the 100-120h/week we spent in the hospital. now that the hours are crunched into 80h, it's honestly difficult to do, especially if you're a new intern and slow at everything. i actually think the "idea" behind work hour restrictions is great; unfortunately the "reality" of it is more complicated and less than ideal in terms of patient safety, patient ownership, and responsible hand-offs.

hours aside, the main difference between medicine and surgery residencies is that surgical residents obviously spend a lot of time in the OR, but we still are responsible for our floor patients. that means you need to get all your s**t done between cases, before cases, skip lunch, hold your bladder, etc. not to diminish the hard work our medicine colleagues do, but it's simply on a less pressured time crunch. surgery residents have to RUN on rounds to see everyone before the OR. sick patients often have to be handled over the phone (while you're scrubbed in a case).

hope this helps. the surgery v. medicine question is one of the hardest ones to decide upon as a med student!

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13 years 7 months ago #57551 by double elle
I was a surgery intern for only 6 months before I switched to medicine....(thank you all for your help through all that, by the way)...Anyway, I didn't find the work or the hours to be so surprising or horrible...I expected the worst. What I did find surprising - and this relates to my program only - is the mentality I was expected to adopt the second I became part of the surgery club. **Sidebar - my decision to switch, for those of you who don't know, had to do with my uneasiness with the program...I thought it lacked stability and I found that it had 100% different tone to it than when I rotated and made my decision to do it.** SOOOoooo.....

For example, when still a surgery intern, I was told that having fun with the medicine people was something looked-down-upon and sooner or later, I'd have to make a choice. Now, I am in a small community hospital. There are only 10 of us INTERNS total...between ALL the programs. I'd gone to medical school with ALL these people and genuinely like them. So, this comment came out of nowhere and stunned me.

Also, there was the "you are doing surgry so you must WANT to be at the hospital 24/7, because that's the only way to learn to do the procedures you need to learn" thinking. Well, I did NOT want to be at the hospital all the time. Yes, I loved it when stuff was going on, but I wasn't about to sit around on a weekend when I could be home with my family and could easily be called in. This was looked down-upon. YET, when rotating and contemplating this program, I was told this sort of family-friendly thinking was perfectly acceptable.

So, it was those things that bothered me about doing surgery. Perhaps I didn't have it in me in the first place to ever to surgery, but the way this program was presented to me....was completely different than what it is now. Granted there have been residents graduate and new residents since I rotated and stuff - and that is where the tone of the program has changed. There have also been staff issues. So, I guess in my defense, the program is completely different than when I matched.
Still, though, I really think the mentality of doing surgery would be expected of me either way. Sure, I would love to be at the hospital and be lucky enough to be there when the really cool things come in. But, I have a 3yo daughter and a husband. I have responsibilities elsewhere, too. I loved surgery, but it wasn't the only thing I love.

Also, I am a selective Type-A. When it comes to work, I am a fanatic. (housework is a different story!) So, wanting to be great at surgery and being a great intern didn't mesh with the nagging feeling in my chest about wanting to be a great mom. I ended up putting so much pressure on myself that when I finally did switch to medicine, I felt that I was floating.

I guess my whole take on the surgery thing is that when you make that committment...it really isn't just you making the committment...it's everyone you love as well. I think in the right program with the right people, and the right support people at home, it's completely do-able. I just think for a woman/mother to do surgery, so many cards have to be aligned correctly and it takes SOOO much work to make that happen. If your husband is a SAHD...that would make all the difference in the world as well. Mine is not.

My final decision is to pursue a branch of medicine that gives me the same rush and has the same intensity as surgery. So, critical care/intensivist work will probably be it for me. I had thought about doing a CC fellowship even after surgery, actually.

Bottom line - be prepared for surprises, not with the work and the hours, but with how you may be expected to think. Fellow residents/attendings may not understand how you don't want to hang out at the hospital as a surgery resident. Some will understand but still believe it's expected - so you do it. Just be sure you investigate the programs well and talk to the JUNIOR residents as well as the seniors...the seniors will be gone when you get there. (my situation!) Best of luck!

One last thing...I don't want anyone to ever think I am trying to talk anyone out of anything... I could have easily transferred to a different surgery program. However, with my husband's job and the financial security we have, we opted to remain where we are and have me simply change specialties. I give all my encouragement to anyone pursuing ANYTHING. I just wanted to give you a few more things to think about - and check on - when rotating/visiting programs and making your desion.

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13 years 7 months ago #57552 by TexasRose
Thanks, ormd and double elle, for sharing your thoughts on this topic. I think this can be really useful for those of us trying to decide what specialty to pursue. Realism is a very handy tool!

I hope more residents and docs will share their thoughts as well. :)

"All you have to decide is what to do with the time that is given to you."

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13 years 6 months ago #57553 by ahaley
Surgery was the only clerkship that I honored in med school. I am now a Medicine PGY3.

I loved surgery, but I turned into a completely different person. I worked 120hrs a week. I actually asked my mother "Why are you bothering me with this right now" when she called to update me on family goings-on, and I told a nurse "get to the point. Oh yeah, I remember screaming at a driver in traffic "you are f....ing it up for everyone" and almost pushing an old man out of the way at the suppermarket when he couldn't figure out how to open the door.

Honestly, I am usually a very patient caring person. And I have been able to maintain that personality in a medicine residency.

I think I would have been a great surgeon, but my marriage would have suffered and I would have hardened a bit.

Medicine is demanding as well (90 hours instead of 120) - we all lie about hours. But overall the people are more tolerant of you having a life outside of the hospital and allow you to be something other than a doctor such as a wife, mother, or human being.

I have the utmost respect for surgeons, but in my personal experience the truely great prestigeous surgeons sacrifice too much for my comfort.

Best of luck.

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